Communication Cards

Michelle KnoxAuckland District Health Board

A tool to support patients with limited or no English

Our Why

Of the 510,450 people living in the Auckland

district, approximately 2 out of every 5 will have

been born overseas, nearly 5% of whom would

struggle to communicate their basic needs in

English (2013 census).

54, 738 interpreter requests

(2015)

“It was a struggle before, we had to guess what patients wanted, you’d go

in circles trying to work out what they wanted, sometimes you could find a

colleague who spoke the same language …”

Staff Nurse, Reablement ward

Current State

What was our current practice?

Current State

What were our resources?

Ad-hoc solutions

What was our remit?

• Imagery needed to be universally

understood (without words);

• Widely applicable across as many cultural

contexts as possible

• Easily accessible by staff and low cost –

e.g. printable from intranet

• Infection control measures considered

• Black and white or with minimal colour to

provide maximum contrast when reading –

especially for older patients

We engaged a group of clinicians

and interpreters to investigate

• How staff currently interacted

with limited or non-English

speaking patients

• What was most difficult to

communicate?

• What was most important?

Human Centred Design

Human Centred Design

We heard:

• Communicating everyday needs with non-English

speaking patients was often difficult, frustrating and

time consuming

• Staff felt concerned that they might not be delivering

the best care for this vulnerable patient group

Prototyping

Prototyping

Cutting and rearranging an early iteration of the icons to make sense of their

order. We settled on Intentional Rounding to guide icon hierarchy – focussing on

priority needs around pain, elimination, positioning, environment, and personal

needs or possessions

Testing for meaning

Examples of universal icon testing with Rangatahi programme students –

acknowledging different interpretations of icons attributed to cultural and contextual

differences, including ethnicity and age.

Testing on wards

Test packs for wards – posters, information and evaluation sheets for staff,

2016. We used PDCA cycles to test iterations in clinical environments where

we got feedback from patients, families and staff regarding the appropriateness

of icon choice and design.

Feedback

November 2016

Communication Cards go live!

How are they being used?

Have we addressed a need?

2300 visits to the communication cards web pages since Nov 2016

Month Hits

Unique

Users

2016-11 183 117

2016-12 109 70

2017-01 102 44

2017-02 764 479

2017-03 207 113

2017-04 94 51

2017-05 102 56

2017-06 101 54

2017-07 77 51

Table shows Hippo

intranet traffic for the

Communication Cards

page. Spike in February

relates to post on eNOVA

(hospital weekly online

newsletter to staff).

There was no obvious measure to demonstrate change; however, we measured

interpreter requests per 1000 patient episodes to ensure no negative

counterbalancing effect and have overlaid post hoc hits on the tool intranet page to

show consumption of the tool

Spreading the message

We also promoted the Communication Cards

via Facebook, Twitter and Instagram.

Facebook: Reach - 4,408(number of

users who would have seen post)

Engagement – 925 (sum of post clicks,

reactions, comments and shares)

Twitter: Impressions/reach - 1,434 and

Engagement – 83

icons@adhb.govt.nz

What are people saying?

“Sometimes we use them as prompts for our patients, for example, a

Tongan gentleman did not know what we meant when we brought him

towels and when we tried to gesture that it was time for a shower, he

did not want to get up. When we showed him the picture for the

shower, he got up straight away to have a wash. Then every day he

knew what the towels meant”.

Charge Nurse, Reablement

What are people saying?

“We were especially fortunate to trial the tool with a patient

who had experienced a fall with harm which was partially

attributed to not being able to communicate her needs to staff.

Feedback regarding the tool was positive, so much so that the

patient took the card with her to her next rehabilitation

placement”

Physiotherapist, Reablement

What are people saying?

“I just wanted to let you know that I have used the communication cards for

patients in our services‘ AOU, whom speak little or no English. It has really helped

me communicate basic ADL needs across better when interpreters are not

available.

I have found the pictures are really helpful when communicating with some

patients who are cognitively impaired.

Its another mode of communication that they can relate to. So I print the cards out

when I am out reviewing patients, more often than not, I have used it for patients

and it been invaluable.

So thank you for all the hard work you put into it”

Key Learnings

• Creating universally understood icons was sometimes difficult and time

consuming – the value of prototyping and testing

• Icons that the public thought were most important differed somewhat

to what staff felt were most important – the value of Human-centred

design, recognising contextual bias

• The prototyping process proved its value when it demonstrated that we

should invest in paying for some simple translations to better meet the

needs of our patients, families and staff

• Patient engagement with vulnerable groups is difficult, especially when

language is a barrier – take opportunities for engagement wherever

you can

Communication Cards

http://www.adhb.health.nz/health-professionals/resources/communication-cards/